The Chemo-Gut Study: A Cross-Sectional Survey Exploring Physical, Mental, and Gastrointestinal Health Outcomes in Cancer Survivors

Abstract

Background Cancer treatments, such as chemotherapy, may adversely affect gastrointestinal (GI), physical and mental health in survivors of cancer. Objective This study investigated associations between GI, mental and physical health outcomes, and cancer treatment-related variables, such as chemotherapy, in adult cancer survivors. Methods A one-time cross-sectional survey with patient-reported outcomes was used. Cancer survivors (N = 317) aged ≥18 years, living in Canada, who completed cancer treatments were included. Descriptive statistics, correlation, and linear regression analyses are reported. Results Mean age at diagnosis was 40.90 ± 15.40 years. Most survivors received chemotherapy (86.1%). Persistent GI symptoms include constipation (53.6%), diarrhea (50.5%), and bloating/pain (54.9%). Mean GI symptom duration was 30.53 ± 33.42 months. Severity of GI symptom interference was moderate to extreme for 51.9% of survivors. Compared to normative values of 50 in healthy people, survivors scored poorer for mental health (M = 42.72 ± 8.16) and physical health (M = 45.55 ± 7.93), and reported more belly pain (M = 56.10 ± 8.58), constipation (M = 54.38 ± 6.81), diarrhea (M = 55.69 ± 6.77), and gas/bloating (M = 56.08 ± 8.12). Greater GI symptom severity was associated with poorer mental and physical health ( P < .01). Chemotherapy was associated with increased belly pain ( B = 4.83, SE = 1.65, P < .01) and gas/bloating ( B = 3.06, SE = 1.45, P = .04). Conclusion We provide novel evidence that many cancer survivors experience chronic, moderate to severe GI symptoms lasting for years after cancer treatment, which are associated with worse mental and physical health. Chemotherapy is associated with specific GI symptoms. Integrative therapies are needed to address GI symptoms in cancer survivors.

Associations Between Health Behaviours, Gastrointestinal Symptoms, and Gut Microbiota in a Cross-Sectional Sample of Cancer Survivors: Secondary Analysis from the Chemo-Gut Study

“…Moreover, compared to healthy peers with no history of cancer, the relative abundances of specific taxa remained different in survivors up to 5-years post-treatment; Certain bacterial taxa were correlated with psychosocial outcomes, including increased depression and poorer cognitive function [28]. Our previous work also found that survivors experience chronic, moderate to severe, GI symptoms, lasting for an average of 2.5 years post-treatment, and that higher GI symptom burden is associated with poorer mental health [29]. However, the potential impact of diet and exercise behaviours on survivors' gut microbiota remains to be elucidated.…”

“…Participants for this secondary analysis were combined from both the Chemo-Gut Pilot study [28] and the Chemo-Gut Survey study [29]. The demographic, clinical, and GI outcome related data were similar between the two studies, thus allowing us to pool the results for the health behaviour and GI outcome data.…”

“…The demographic, clinical, and GI outcome related data were similar between the two studies, thus allowing us to pool the results for the health behaviour and GI outcome data. The full methodology including sample size calculations are previously described [28,29]. Briefly, participants for the survey study cohort were recruited virtually via social media channels, and the sample was comprised of Canadians who had previously been diagnosed with cancer, were currently aged 18 years or older, and had received and completed anti-cancer therapies (e.g.…”

“…All demographic, clinical, and GI outcome measures were administered via a link made available to participants through Remote Electronic Data Capture (REDCap), a secure browser-based application designed to support Electronic Data Capture for research studies provided through the Clinical Research Unit (CRU) in the University of Calgary Cumming School of Medicine. Full data and stool collection procedures are previously described [28][29][30]. Briefly, participants were instructed to use the investigator-provided home stool collection kit.…”

“…Details regarding patient reported outcomes have previously been published [29,30]. The demographic and clinical health outcomes questionnaire was a locally designed survey that was developed based on patient partner input, and coauthor expertise.…”